Individual
MR. RODNEY CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4146 E. 61ST STREET, INDIANAPOLIS, IN 46220
(317) 696-0454
Mailing address
4146 E. 61ST STREET, INDIANAPOLIS, IN 46220
(317) 696-0454
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200974600 A
LEGACY PROVIDER IDENTIFIER
IN
Enumeration date
08/03/2015
Last updated
08/03/2015
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